Gliederung

Objective: Increasing experience with standard endoscopic transsphenoidal procedures has also led to the use of extended transsphenoidal approaches for intradural lesions, such as craniopharyngeomas and meningeomas. Commonly accepted rules for the use of one or the other route are missing. Generally, the transsphenoidal approach is thought to be less invasive despite a higher risk of CSF leaks and nasal complications. Further advances in transcranial endoscopic skull base approaches provide comparable minimal invasive procedures. The aim of this study is to compare transcranial and transsphenoidal endoscopic procedures for similar pathologies.

Methods: Transcranial and transsphenoidal endoscopic procedures for 32 intradural tumors of the anterior skull base and sellar region were retrospectively analysed. Criteria were time for approach, time for tumor dissection, grade of tumor removal, as well as approach- and dissection-related complications. Lesions included meningeomas, craniopharyngeomas, epidermoids, pituitary adenomas and metastases. Lesions were approached either by a binostril transsphenoidal endoscopic (n=11) or a supraorbital endoscope-assisted keyhole (n=21) approach using the MINOP Trend endoscope system (Aesculap, Tuttlingen/Germany) in case of transsphenoidal surgery and the MINOP Team endoscope system (Aesculap, Tuttlingen/Germany) in case of transcranial surgery.

Results: The time required for the approach and for tumor dissection was found to be longer with 36 and 58 minutes in transsphenoidal surgery compared to transcranial surgery with 21 and 54 minutes. Complete tumor removal was achieved in 10/11 cases using the transsphenoidal route and in 19/21 cases using the transcranial route. CSF leaks were more frequent for anterior fossa lesions using the transsphenoidal approach (2/11 versus 0/21) whereas cranial nerve deficits where more prominent in sellar region lesions approached transcranially (2/21 versus 0/11).

Conclusions: The transcranial endoscopic technique seems to be superior for intradural lesions of the anterior skull base in terms of time for surgery and CSF leaks. The transsphenoidal technique has a slightly lower dissection-related morbidity in intradural sellar lesions.